{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lori H Haynes","gend":1,"add":"682 Greene Settlement Rd","city":"Gray","state":"GA","zip":31032,"dob":"1971-05-26","age":"","mstatus":"","insh":4562475001,"cliId":"","pno":4788412357,"cno":"","email":"lorihaynes@windstream.net","ename":"","eno":"","pphy":"Stephen Durso","ppno":"","pcpadd":"1062 Forsyth St,Suite 3-","pcpcity":"Macon","pcpstate":"GA","pcpzip":"","pcpcounty":"Macon","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N94.6","E53.8","Z01.419","R87.610","C07","Z01.810","E66.9","I10","F33.1","J30.9","R51","Z68.33","Z13.31","Z13.89","E11.9","K80.00","K82.8","E78.1","R73.9","R73.03","Z20.828","Z87.891","Z20.822","R11.2","D37.030","R51.9","Z71.89","K21.9","Z71.3","E78.5","D25.2","N72","N88.8","N83.02","N83.01","L65.9","Z12.31","N76.0","Z12.11","Z20.2","Z30.431","Z11.3","Z68.32","R22.0","K80.20","R07.9","N92.0","N93.0","K81.0","Z79.899","D75.89","R10.11","K11.8","J98.01","R50.9","M79.10","R53.81","Z87.09","Z13.83","R68.83","R52","G43.829","G43.109","Z01.818","Z68.30","R10.84","R10.9"],"date":["2021-11-09","2021-06-29","2021-02-11","2021-02-11","2021-11-23","2020-04-09","2021-11-09","2021-12-28","2021-06-29","2021-06-29","2020-04-09","2020-04-09","2021-06-29","2021-06-29","2020-12-01","2020-12-01","2020-12-01","2021-12-28","2021-12-28","2021-12-28","2021-06-01","2021-11-18","2021-10-20","2020-10-20","2020-06-23","2021-06-29","2021-06-29","2021-11-09","2021-06-29","2021-06-29","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2020-09-29","2020-03-12","2020-03-12","2021-02-09","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-03","2020-10-13","2020-10-13","2021-11-09","2021-11-09","2021-01-19","2021-02-09","2020-05-12","2020-10-20","2021-02-16","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-06-01","2021-06-01","2021-05-04","2021-05-04","2021-03-02","2021-06-29","2021-02-16","2021-11-09","2020-06-16","2020-07-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","69097012203","TOPIRAMATE","25MGTABLET","120","Select","Select",""],["","13668001105","CITALOPRAM","HBR40MGTABLET","30","Select","Select",""],["","43547028810","BUPROPION","HCLSR100MGTABLET","30","Select","Select",""],["","378415105","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","16714079801","SUMATRIPTAN","SUCC100MGTABLET","9","Select","Select",""],["","69315012710","FOLIC","ACID1MGTABLET","30","Select","Select",""],["","143962125","CYANOCOBALAMIN","1000MCG\/ML","1","Select","Select",""],["","72618300002","NURTEC","ODT75MGTABLET","8","Select","Select",""],["","31722094901","OXYCODONE-ACETAMINOPHEN","5-325","25","Select","Select",""],["","45802006436","TRIAMCINOLONE","0.001CREAM","80","Select","Select",""],["","65862018830","ONDANSETRON","HCL8MGTABLET","24","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","406012401","HYDROCODONE-ACETAMIN","7.5-325","5","Select","Select",""],["","16714029904","AMOXICILLIN","500MGCAPSULE","14","Select","Select",""],["","42806031205","DOXYCYCLINE","HYCLATE100MGTAB","20","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","21","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","16714001401","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","60758018805","GENTAMICIN","0.003EYEDROP","5","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}